Efficacy and safety of partial splenic embolization for hypersplenism in pre- and post-liver transplant patients: A 16-year comparative analysis

DuBois, Byron G.; Mobley, D.; Srinivasa, Ravi N.; Wilcox, Chad; Weintraub, Joshua

doi:10.1016/j.clinimag.2018.11.012

Cited by 12 publications

(8 citation statements)

References 49 publications

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“…The ability to reliably assess splenic vascular flow may aid the clinical workup of hypersplenism 33 or serve a role in identification of candidates for partial splenic embolization 34,35 . A previously reported 4D flow‐based metric termed the splenic flow index was reported to be superior to splenic volume and simple blood flow measures in predicting the serological derangements of cirrhosis‐associated hypersplenism 36 .…”

Section: Discussionmentioning

confidence: 99%

Quantification of the Hemodynamic Changes of Cirrhosis with Free‐Breathing Self‐Navigated MRI

Brunsing

Brown

Almahoud

et al. 2021

Magnetic Resonance Imaging

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Background Non‐invasive assessment of the hemodynamic changes of cirrhosis might help guide management of patients with liver disease but are currently limited. Purpose To determine whether free‐breathing 4D flow MRI can be used to quantify the hemodynamic effects of cirrhosis and introduce hydraulic circuit indexes of severity. Study Type Retrospective. Population Forty‐seven patients including 26 with cirrhosis. Field Strength/Sequence 3 T/free‐breathing 4D flow MRI with soft gating and golden‐angle view ordering. Assessment Measurements of the supra‐celiac abdominal aorta, supra‐renal abdominal aorta (SRA), celiac trunk (CeT), superior mesenteric artery (SMA), splenic artery (SpA), common hepatic artery (CHA), portal vein (PV), and supra‐renal inferior vena cava (IVC) were made by two radiologists. Measures of hepatic vascular resistance (hepatic arterial relative resistance [HARR]; portal resistive index [PRI]) were proposed and calculated. Statistical Analysis Bland–Altman, Pearson's correlation, Tukey's multiple comparison, and Cohen's kappa. P < 0.05 was considered significant. Results Forty‐four of 47 studies yielded adequate image quality for flow quantification (94%). Arterial structures showed high inter‐reader concordance (range; ρ = 0.948–0.987) and the IVC (ρ = 0.972), with moderate concordance in the PV (ρ = 0.866). Conservation of mass analysis showed concordance between large vessels (SRA vs. IVC; ρ = 0.806), small vessels (celiac vs. CHA + SpA; ρ = 0.939), and across capillary beds (CeT + SMA vs. PV; ρ = 0.862). Splanchnic flow was increased in patients with portosystemic shunting (PSS) relative to control patients and patients with cirrhosis without PSS (P < 0.05, difference range 0.11–0.68 liter/m). HARR was elevated and PRI was decreased in patients with PSS (3.55 and 1.49, respectively) compared to both the control (2.11/3.18) and non‐PSS (2.11/2.35) cohorts. Data Conclusion 4D flow MRI with self‐navigation was technically feasible, showing promise in quantifying the hemodynamic effects of cirrhosis. Proposed quantitative metrics of hepatic vascular resistance correlated with PSS. Level of Evidence 3 Technical Efficacy Stage 2

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Section: Discussionmentioning

confidence: 99%

Quantification of the Hemodynamic Changes of Cirrhosis with Free‐Breathing Self‐Navigated MRI

Brunsing

Brown

Almahoud

et al. 2021

Magnetic Resonance Imaging

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“…Zaitoun et al [ 31 ] reported that PLT reached a peak level of 155.56 ± 30.7 G/L and WBC rose to a peak level of 7.5 ± 1.7 G/L 2 weeks after PSE. It is reported by DuBois et al [ 32 ] that PSE is efficacious in increasing WBC count out to 2 years and platelet count out to 3.5 years in patientswith hypersplenism. Gu et al [ 33 ] reported that WBC peaked at 2 weeks after PSE and then gradually decreased, but it was still significantly higher than the preoperative level during the 4 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of heparin plus dexamethasone after partial splenic embolization for liver cirrhosis with massive splenomegaly

Zheng

Xiong

et al. 2022

BMC Gastroenterol

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Purpose The aim of this study was to investigate the efficacy and safety of the combination of low-molecular-weight heparin + dexamethasone after partial splenic embolization in cirrhotic patients with massive splenomegaly. Methods This study included 116 patients with liver cirrhosis complicated with massive splenomegaly who underwent PSE in Union Hospital from January 2016 to December 2019, and they met the criteria. They were divided into two groups: PSE + Hep + Dex group (N = 54) and PSE group (N = 62). We conducted a retrospective study to analyze the efficacy and safety of the two groups of patients. Results The volume of splenic embolization was 622.34 ± 157.06 cm3 in the PSE + Hep + DEX group and 587.62 ± 175.33 cm3 in the PSE group (P = 0.306). There was no statistically difference in the embolization rate of the spleen between the two groups (P = 0.573). WBC peaked 1 week after PSE and PLT peaked 1 month after PSE in both groups; it gradually decreased later, but was significantly higher than the preoperative level during the 12-month follow-up period. The incidences of abdominal pain (46.3% vs 66.1%, P = 0.039), fever (38.9% vs 75.8%, P < 0.001), PVT (1.9% vs 12.9%, P = 0.026), refractory ascites (5.6% vs 19.4%, P = 0.027) were lower in the PSE + Hep + DEX group than in the PSE group. The VAS score of abdominal pain in PSE group was higher than that in PSE + Hep + DEX group on postoperative days 2–8 (P < 0.05). Splenic abscess occurred in 1(1.6%) patient in the PSE group and none (0.0%) in the PSE + Hep + DEX group (P = 0.349). Conclusions The combined use of dexamethasone and low-molecular-weight heparin after PSE is a safe and effective treatment strategy that can significantly reduce the incidence of complications after PSE (such as post-embolization syndrome, PVT, refractory ascites).

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“…59 For patients undergoing liver transplant which may be complicated by graft dysfunction or hepatitis C, 60 these therapeutic benefits of PSE persist. 61 Recently, PSE has undergone several advances in technique and technology. Although most frequently performed via a transfemoral approach, patients undergoing PSE via transradial approach for hypersplenism had a shorter procedure time, X-ray exposure time, and hospital length of stay in a prospective randomized controlled trial.…”

Section: Discussionmentioning

confidence: 99%

Partial Splenic Artery Embolization to Treat Portal Hypertension

Srinivas

Yeluru

Berman

et al. 2022

Digestive Disease Interventions

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Portal hypertension (PH) commonly occurs in the setting of underlying liver disease and can precipitate variceal bleeding and ascites among other complications. Traditionally, PH is managed with medication or lifestyle changes with refractory cases treated with transjugular intrahepatic portosystemic shunts or splenectomy. Partial splenic artery embolization (PSE) is an alternative treatment which may reduce PH by decreasing splenic vein inflow into the portal vein. In this article, we review the efficacy of PSE and present illustrative cases with a focus on technical and clinical considerations for embolization. We queried the PubMed database from August 1976 to September 2021 for clinical studies of PSE for the treatment of portal hypertension. For each article, the author, year, title, study design, number of patients, age, sex, liver function, technical considerations, adverse effects, and outcomes were recorded. We also review two successful and unsuccessful cases from our institution. A total of 12 studies were identified with 258 patients undergoing 290 PSE treatments. The mean age of patients was 44.1 years (range: 6–77). Most patients had well-compensated liver disease (Child–Pugh (CP) A; 35.1%) or significant functional compromise (CP-B; 44.4%), but a few had decompensated disease (CP-C; 8.9%). The majority (91.7%) of procedures were performed distally within the splenic artery, and on average, 59.5% (20–100) of the spleen underwent infarction. Common complications included symptoms of postembolization syndrome such as abdominal pain (58.5%) and fever (53.2%) as well as atelectasis (9.0%). Five PSE procedures (1.7%) resulted in death secondary to pleuropneumonia, splenic abscess, sepsis, intracranial hemorrhage, and pulmonary embolism, respectively. PSE is an effective but often underutilized treatment for PH. These benefits have risk for minor complications including postembolization syndrome and major complications such as splenic abscess formation. This article will introduce the reader to important technical and clinical considerations regarding PSE.

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Efficacy and safety of partial splenic embolization for hypersplenism in pre- and post-liver transplant patients: A 16-year comparative analysis

Cited by 12 publications

References 49 publications

Quantification of the Hemodynamic Changes of Cirrhosis with Free‐Breathing Self‐Navigated MRI

Quantification of the Hemodynamic Changes of Cirrhosis with Free‐Breathing Self‐Navigated MRI

Efficacy and safety of heparin plus dexamethasone after partial splenic embolization for liver cirrhosis with massive splenomegaly

Partial Splenic Artery Embolization to Treat Portal Hypertension

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